LGBTQ Queer Peers Mentoring Program: Application for Current Students to be a Mentor

Mentors are Dickinson College students who identify as LGBTQIA and are excited to connect and establish rapport with their fellow students. They will provide support concerning issues with sexual orientation and/or gender identity as well as ways to navigate Dickinson and the world as an LGBTQIA identified individual.

Mentors will receive training and materials helpful to serving as a mentor, provide understanding and support to your mentee, and have continued support from the Office of LGBTQ Services. Mentors provide positive role modeling, on-going support, understanding, empowerment, acceptance, information, networking, resources, connection, and guidance to the mentees enrolled in the program.

* Required

First Name
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This is a required question

Last Name
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This is a required question

Preferred Name

This is a required question

Email
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This is a required question

Home Address
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This is a required question

Campus Address
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This is a required question

Phone Number
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This is a required question

Use Discretion when calling
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Yes

No

This is a required question

Major(s) / Minor(s)
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This is a required question

Graduation Year
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This is a required question

GPA

This is a required question

Date of Birth
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This is a required question

Age
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Sex
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Female

Male

Intersex

Self Identify

Other:

This is a required question

Gender
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Woman

Man

Transgender

Self Identify

Other:

This is a required question

Sexual/Affectional Orientation
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Lesbian

Gay

Bisexual

Queer

Questioning

Asexual

Aromantic

Ally

Self Identify

Other:

This is a required question

Gender Identity/Expression

(i.e. male, female, non-binary, genderqueer, etc.)

This is a required question

Racial/Ethnic Background(s) with which you identify

Arab/Middle Eastern American

Asian/Pacific American

Native American/Alaska Native/Pacific Islander

Black/African American

Chican@/Latin@/Hispanic American

White/European American

Multiracial

International

Self Identify

Other:

This is a required question

Are you an International Student?
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Country of Origin
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This is a required question

Religious/Spiritual Ideology (if any)

This is a required question

What brings you to the Queer Peers Mentoring Program?
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This is a required question

What are some of your interests in being a Queer Peers Mentor to a fellow Dickinson College student?
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This is a required question

What are some of your educational/professional goals/interests?
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This is a required question

How did you hear about the Queer Peers Mentoring Program?
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This is a required question

What involvement, if any, do you have with the LGBTQ community at Dickinson? Outside of Dickinson?
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This is a required question

DISCLAIMER: The Program attempts to match mentees with mentors based on similarities in characteristics, such as sexual orientation, gender, interests, and race/ethnicity. In the event that a mentee with the same characteristics as yours is not available, the program will match you with the person who is most similar to you. If you have any comments, wish to add any additional information, or have any preferences for a type of mentee, please note them here. You are strongly encouraged to list those traits which are important to you for your mentee to share (i.e. ethnicity, religion, etc.).